Abstract
Background and AimPoint‐of‐care ultrasound (POCUS) is a noninvasive alternative to ileocolonoscopy for monitoring disease activity in inflammatory bowel disease (IBD) but is underutilized in practice. Accuracy data are needed to engender clinician confidence in POCUS and increase uptake. The aim of this study was to evaluate the accuracy of POCUS compared to ileocolonoscopy in detecting active disease and extent in patients with IBD.MethodsA prospective, blinded study was performed at a single tertiary center in South Australia between May 2017 and May 2018. Consecutive patients with a formal diagnosis of IBD who underwent both POCUS and ileocolonoscopy within 30 days of one another, performed to evaluate IBD disease activity, were eligible for participation. The accuracy of POCUS compared to ileocolonoscopy was assessed using sensitivity, specificity, and Cohen's kappa coefficient analyses.ResultsA total of 74 patients were included in the final analysis, 35 (47%) of whom had Crohn's disease and 39 (53%) ulcerative colitis; 37 subjects (50%) underwent a POCUS and ileocolonoscopy on the same day. POCUS demonstrated 91% sensitivity and 83% specificity for detecting endoscopically active IBD, correlating with a positive predictive value (PPV) of 89%, a negative predictive value (NPV) of 86%, and a kappa coefficient of 0.74 (88%). POCUS defined disease extent with 87% sensitivity and 81% specificity, correlating with a PPV of 85% and NPV of 83% and a kappa coefficient of 0.70 (85%).ConclusionPOCUS is accurate in defining disease activity and extent in IBD compared to ileocolonoscopy. POCUS represents an appealing, noninvasive alternative to ileocolonoscopy for monitoring disease activity in IBD.
Highlights
Expansion in the armamentarium of effective treatment options for inflammatory bowel disease (IBD) has evolved goals of therapy.1 Beyond symptom resolution, mucosal healing is aggressively pursued as a therapeutic target in IBD as it is associated with decreased rates of hospitalization, surgery, steroid use, and risk of malignancy.1–6Clinical symptoms correlate poorly with inflammatory burden in IBD.7 objective assessment of disease activity is recommended to guide ongoing management.1 The gold standard for assessing disease activity in IBD is ileocolonoscopy.1 ileocolonoscopy is invasive and is associated with risks to patients, not to mention the discomfort and inconvenience of bowel preparation.8 the frequency at which ileocolonoscopy is recommended for monitoring IBD poses an enormous economic burden on health systems
Point-of-care ultrasound (POCUS) was found to be accurate compared to ileocolonoscopy in assessing disease activity and extent in the routine monitoring of patients with IBD
POCUS was more accurate for defining disease activity and extent in patients with ulcerative colitis (UC) and was more accurate than fecal calprotectin (FC) in predicting disease activity
Summary
Expansion in the armamentarium of effective treatment options for inflammatory bowel disease (IBD) has evolved goals of therapy. Beyond symptom resolution, mucosal healing is aggressively pursued as a therapeutic target in IBD as it is associated with decreased rates of hospitalization, surgery, steroid use, and risk of malignancy.1–6Clinical symptoms correlate poorly with inflammatory burden in IBD. objective assessment of disease activity is recommended to guide ongoing management. The gold standard for assessing disease activity in IBD is ileocolonoscopy. ileocolonoscopy is invasive and is associated with risks to patients, not to mention the discomfort and inconvenience of bowel preparation. the frequency at which ileocolonoscopy is recommended for monitoring IBD poses an enormous economic burden on health systems. Point-of-care ultrasound (POCUS) is a noninvasive alternative to ileocolonoscopy for monitoring disease activity in inflammatory bowel disease (IBD) but is underutilized in practice. The aim of this study was to evaluate the accuracy of POCUS compared to ileocolonoscopy in detecting active disease and extent in patients with IBD. The accuracy of POCUS compared to ileocolonoscopy was assessed using sensitivity, specificity, and Cohen’s kappa coefficient analyses. POCUS demonstrated 91% sensitivity and 83% specificity for detecting endoscopically active IBD, correlating with a positive predictive value (PPV) of 89%, a negative predictive value (NPV) of 86%, and a kappa coefficient of 0.74 (88%). POCUS defined disease extent with 87% sensitivity and 81% specificity, correlating with a PPV of 85% and NPV of 83% and a kappa coefficient of 0.70 (85%). POCUS represents an appealing, noninvasive alternative to ileocolonoscopy for monitoring disease activity in IBD
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